The Public Health Emergency, initiated in 2020 and continuing to the present, established a new and complex means of getting healthcare.
Because many were worried about social distancing and leaving their residences, office visits to a doctor or healthcare provider initially diminished, then frequently became phone visits or telehealth visits. In response to COVID, Medicare and most insurers broadened their coverage for telehealth visits, so the patients didn’t have to leave their homes.
Currently, 42 states and Washington, D.C. have required insurance coverage of telemedicine visits. The CPT codes for these visits are based on the duration of the visit, and the reimbursement for the codes is less than in-office visits, but commensurate with the ability to provide care in a remote location.
There’s a difference between telehealth and telemedicine. It’s a fine difference, but it’s an important one. Telehealth is a broader term and covers all electronic means and media for remote care. Telemedicine refers to the actual practice of medicine remotely and is reimbursable. Telemedicine can be used for non-urgent recurring conditions, skin conditions, lab results, and PT and OT.
Medicare and other insurances cover telemedicine use with specific CPT codes and can be used in cases where the patient is geographically removed from the practitioner or is physically unable to be present. Because therapy is so frequently a “hands-on” experience, the efficacy of the practice is often disparaged. But when a patient shows competence and compliance with their program and the therapist’s availability is limited, the use of technology is frequently the best option. If a patient requires a hands-on manual treatment technique, telemedicine is not the right choice.
As a therapist, I was skeptical about remote therapy. How could we evaluate and assess strength, motion and function? How could we determine if the patient’s pain was musculoskeletal or neurological if we couldn’t palpate for muscle spasms or guarding?
It became apparent that self-reporting by the patient or by their caregiver was adequate for assessing and treating the patient and by observing their effort. Functional movement could be evaluated by watching the patient’s posture, progress, and home safety. When we were unable to do a typical home safety evaluation, we asked a family member to take us through the home electronically. The patient sat by our side and watched and offered information on the challenges we saw in the home. Telehealth saves time, money and sanity.
How effective is the use of telemedicine? How does it work for Physical and Occupational Therapies in a situation where an elderly person requires Part B services, but lives in a long-term facility and doesn’t have access to or is too physically compromised to attend in-person therapy? All that’s required is an internet connection, secure communication software, and access to a smartphone or laptop.
According to the American Physical Therapy Association, telehealth solutions fall under the broad umbrella of “digital health technologies”. It’s all about patient access. Telehealth by PT/OT has proven to produce good outcomes with little risk to the patient. While not appropriate in every case, it may be the best and sometimes the only option for those in intermediate care, assisted living, or in remote areas with little access to therapy. Last year a study that addressed therapy telehealth for orthopedic, vestibular, neurologic, cardiovascular, and other pathologies concluded that “Where appropriate, the implementation of telerehabilitation in clinical practice could therefore be considered an alternative or complementary option to traditional in-person care.”
Despite the growing and well-established use of telemedicine, many practitioners are still reluctant to use it. Among their concerns is that it can be dangerous to older adults because of their complex needs. Support, guidelines and education for therapists and other practitioners on the best use of technology can provide effective, equitable and optimal outcomes for older adults.
While most of us have access to in-person therapies for our residents, there continue to be staffing challenges and geographical challenges that may impede our ability to care for our residents. Because of the pandemic-enforced increases in acceptance of telehealth, our ability to provide care for everyone has increased and it is an available platform for everyone to get the care they need.
Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD, is the regional director of therapy operations at Diversified Health Partners in Ohio.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
